Are We Limiting Our Own Scope?
“How often have you heard a teacher say, ‘The student is struggling with their OT skills’?”
Too often.
Many school-based occupational therapists continue to be viewed (and sometimes function) within a scope shaped by outdated perceptions.
We’re still frequently seen as the fine motor or sensory specialists, rather than as professionals uniquely equipped to address what students with ADHD actually struggle with most: participation in meaningful school occupations.
When ADHD is framed narrowly, OT support becomes narrowly applied. The result is well-intended intervention that never quite reaches the point of performance.
What Best Practice Tells Us, And What It Doesn’t
Current best practice guidance is not wrong. Resources such as Best Practices for Occupational Therapy in Schools (2nd Ed.) byClark et al. outline a wide range of appropriate roles for school-based OT, including:
- collaborating with families and teachers
- adapting environments and routines
- delivering Tier 1 supports
- addressing sensory modulation when relevant
- integrating educational and behavioral strategies
- using person–environment–occupation models to support participation
All of this matters.
And yet, something critical is missing.
What we are rarely given is a framework for organizing this work in real classrooms. There is little guidance for translating theory into action, prioritizing supports, or making decisions when everything feels relevant.
What practitioners are left with is an overwhelming menu of options, fragmented, choice-heavy, and difficult to implement consistently.
Decision fatigue is real, especially when supporting students with ADHD.
Without a clear framework, even evidence-aligned practices become hard to apply, hard to sustain, and hard to generalize.
Why Common Approaches Fall Short
Over time, I’ve seen several well-intended approaches repeatedly miss the mark not because they’re ineffective in theory, but because they don’t align with how ADHD actually shows up in classrooms.
Generic professional development often stays too broad. Teachers don’t need more information about ADHD; they need student-specific strategies embedded in their existing systems.
Lengthy accommodation checklists can overwhelm rather than support. Faced with too many options, teachers disengage quickly, feeling as though they’ve “tried everything” after only a few ideas.
Consultation without integration rarely sticks. Advice that isn’t embedded into classroom routines is easy to agree with and just as easy to forget.
Pull-out intervention models present another challenge. What works in a highly supportive, small-group OT setting does not automatically generalize to the classroom.
Students with ADHD behave differently depending on the context and the occupation. If support stays in OT, it stays in OT.
Finally, a sensory-only lens is too narrow. While sensory factors may be relevant, ADHD is fundamentally a disorder of executive function and self-regulation. Support must reflect that reality.
Introducing EASE: A Functional Framework That Works
To meaningfully support participation and performance, intervention must be designed around the student’s ability to function in a specific context, at the point of performance. That is the heart of occupational therapy and the foundation of the EASE Framework.
EASE is not a list of interventions. It is a functional framework that helps therapists organize their thinking, prioritize supports, and design systems that work in real classrooms.
The framework rests on four interdependent conditions for performance:
Educate
Build shared understanding of ADHD as a disorder of executive function and self-regulation. Reduce stigma, increase empathy, and support generalization through ongoing, collaborative problem-solving, not one-and-done PD.
Accommodate
Design contexts that support access. Modify environmental, social, and attitudinal factors; assess the goodness of fit between student and environment; and create external supports aligned with ADHD severity and co-occurring needs. Context is everything when it comes to ADHD.
Scaffold
Support performance while executive functions are still developing. Scaffold task initiation, working memory, persistence, and completion at the point of performance, using prompts, modeling, and guided self-monitoring.
Empower
Shift from compliance to ownership. Students with ADHD receive far more negative messages than their peers. They don’t need to be told to try harder they need permission and guidance to try differently. Empowerment reduces shame, builds self-advocacy, and protects long-term outcomes.
Why a Framework Matters
ADHD creates dynamic, context-dependent performance challenges. There is no single intervention that works across students, settings, or developmental stages.
What does work is a framework that allows therapists to:
- interpret performance accurately
- design supports intentionally
- collaborate effectively with teachers and families
- sustain change over time
The role of the school-based occupational therapist is essential in facilitating functional performance for students with ADHD. But that role is only as effective as the framework guiding it.
Want to learn how to build these systems?
Explore how The EASE Framework can help you design sustainable, practical supports that make success possible. [Learn more about The EASE Framework
Resources
Beisbier, S., & Cahill, S. (2021). Occupational Therapy Interventions for Children and Youth Ages 5 to 21 Years. AJOT, 75(4). https://doi.org/10.5014/ajot.2021.754001
American Occupational Therapy Association. (2020). OTPF: Domain and Process (4th ed.). AJOT, 74(S2). https://doi.org/10.5014/ajot.2020.74S2001
Hahn-Markowitz, J., et al. (2017). Impact of Cog-Fun on executive functions and participation. AJOT, 71. https://doi.org/10.5014/ajot.2017.022053
Toffel, A., Rhein, J., Khetani, M. A., Pizur-Barnekow, K., James, L. W., & Schefkind, S. (2017). Partnering with families is best practice and essential in promoting school readiness and healthy development. OT Practice, 22(18), 9–13.
Occupational Therapy Association. (2015). Importance of interprofessional education in occupational therapy curricula. American Journal of Occupational Therapy, 69(Suppl. 3), 691341 020. https://doi.org/10.5014/ajot.2015.696S02
American Occupational Therapy Association. (2013). Cognition, cognitive rehabilitation, and occupational performance. American Journal of Occupational Therapy, 67(6 Suppl.), S9–S31.http://doi.org/10.5014/ajot.2013.67S9
CAST, Inc. (2021). The UDL guidelines. https://udlguidelines.cast.org
Dunn, W. (2017). Coaching: An evidence-based practice that supports participation and efficacy [online course].